Continuum consults

Question 1

causes of abulia?

Answer 1

thalamic or orbitofrontal infarcts

Question 2

causes of agitation

Answer 2

PCA and nondominant parietal infarcts

Question 3

what is marchiafava bignami?

Answer 3

demyelination of corpus callosum due to nutritional deficiency in chronic alcoholics

Question 4

what AED shouldnt be used with VPA?

Answer 4

topiramate: causes encephalopathy

Question 5

what shouldn’t you use antipsychotics in?

Answer 5

Lewy body dementia

Question 6

what is the syndrome and treatment? spells of choreiform or dystonic movements for seconds-minutes during movement or with startle?

Answer 6

paroxysmal kinesigenic choreoathetosis: a paroxysmal dyskinesia.

Question 7

Kernig test

Answer 7

meningitis with resistance to passive extension at knee when lying on back

Question 8

brudzinski test

Answer 8

meningitis with neck flexion there is flexion of hips/knees

Question 9

meningitis to give steroids in?

Answer 9

pneumococcal

Question 10

What causes waterhouse friderichsen disease?

Answer 10

N. meningo, with hemorrhage / adrenal failure

Question 11

bugs (2) causing basilar meningitis

Answer 11

Cryptococcus, TB

Question 12

Guess the bug: meningo encephalitis with tremor, diarrhea, rash, flaccid weak limb or parkinsonian.
MRI findings? What is the dx lab test?

Answer 12

WNV, look for CSF IgM Abs, MRI hsows hyperintense thalami, BG, SN

Question 13

EEG findings in HSV encephalitis?

Answer 13

periodic sharp/slow wave complexes at 1-3 sec intervals between 2-15 days

Question 14

What test confirms EBV as cause of encephalitis?

Answer 14

Both CSF PCR AND EBV nuclear Ag negative AND EBV capsid antigen positive (positive EBNA only can be nonspecific)

Question 15

worst endocarditis risk factor

Answer 15

prosthetic mitral valve

Question 16

Risk of stroke if EF < 40%

Answer 16

18%!, each decr 5% EF increases 5yr stroke risk by 8%

Question 17

what causes atrophy of type II fibers, fast twitch glycolytic muscles but with normal labs?

Answer 17

steroid myopathy

Question 18

Dx for this EMG: / NCS: slow NC velocity, prolonged or absent F waves, conduction block?

Answer 18

GBS

Question 19

What might you see in axonal type GBS on EMG/NCS?

Answer 19

spared sensory but low/absent CMAPs and early denervation

Question 20

Mechanism in Botulism

Answer 20

Presynaptic toxin NM blockade preventing ACh release

Question 21

EMG findings in botulism?

Answer 21

Decr CMAP, incremental response to tetanic stim

Question 22

mechanism of ciguatera neurotoxin action?

Answer 22

ingestion of na-channel blocker ingestion, causing acute demyelinating neuropathy

Question 23

two problems to think of when you get symmetric weakness no sensory, no demyelination?

Answer 23

1. Tick paralysis: NMJ problem or distal axon

2. AIP (porphyria), spares CNs, lots of autonomic issues

Question 24

if a MG patient has poor response to acetylcholinesterase inhibitors, think of what?

Answer 24

anti-MUSK

Question 25

best EMG test for MG?

Answer 25

single fiber EMG

Question 26

what is the path and EMG finding in critical illness myopathy

Answer 26

path is loss of thick filaments

EMG is low amp CMAPs, preserved SNAPs, no decrement, small polyphasic MUPs

Question 27

fibrillations and positive sharp waves are seen in what?

Answer 27

polyneuropathy

Question 28

Where do you see shrinking lung syndrome?

Answer 28

neuropathy and diaphragmatic weakness in SLE

Question 29

Treatment of periodic kinesthogenic choreoathetosis.

Answer 29

Treat with Carbamazepime (Na-channel blocker)